Active NPI
Joan Kendall Ayala, LCSW CADC III CRM
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1376952796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- L7815
- Practice address
- 610 SW Alder St Ste 915
Portland, OR 97205 - Phone
- (971) 226-1501
- Fax
- (503) 335-8125
- NPI assigned
- Aug 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 17-01-28 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | |||
| Mental Health Counselor | 101YM0800X | L7815 | OR | Primary |
Addresses
Primary practice location
610 SW Alder St Ste 915
Portland, OR 97205
Mailing address
12265 SW Denfield St
Beaverton, OR 97005-1704
Phone (971) 226-1501
Other practice location 1
12265 SW Denfield St
Beaverton, OR 97005-1704
Phone (971) 226-1501
Other practice location 2
1455 NW Irving St Ste 200
Portland, OR 97209-2275
Phone (503) 842-7855
Other practice location 3
3650 NE Mallory Ave
Portland, OR 97212-2044
Phone (503) 335-0855
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16CRM233 | Other | OR | ACCBO CRM |
| L7825 | Other | OR | LICENSED CLINICAL SOCIAL WORKER |
| A4288 | Other | OR | BOARD OF LICENSED CLINICAL SOCIAL WORKERS |
| 17-01-0128 | Other | OR | ACCBO CADC III |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L7815 | OR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Well Coast Medical Corporation | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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Multi-Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614297600000",
"number": "1376952796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12265 SW DENFIELD ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970051704",
"telephone_number": "971-226-1501",
"fax_number": "971-339-0401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 SW ALDER ST STE 915",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97205",
"telephone_number": "971-226-1501",
"fax_number": "503-335-8125"
}
],
"practiceLocations": [
{
"address_1": "12265 SW Denfield St",
"address_purpose": "LOCATION",
"city": "Beaverton",
"state": "OR",
"postal_code": "970051704",
"country_code": "US",
"telephone_number": "971-226-1501",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1455 NW Irving St Ste 200",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972092275",
"country_code": "US",
"telephone_number": "503-842-7855",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3650 NE Mallory Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972122044",
"country_code": "US",
"telephone_number": "503-335-0855",
"fax_number": "503-335-8125",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AYALA",
"first_name": "JOAN",
"middle_name": "KENDALL",
"name_prefix": "Ms.",
"credential": "LCSW CADC III CRM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-11",
"last_updated": "2021-02-26",
"certification_date": "2021-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor",
"state": "OR",
"license": "17-01-28",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "L7815",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACCBO CRM",
"identifier": "16CRM233",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED CLINICAL SOCIAL WORKER",
"identifier": "L7825",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF LICENSED CLINICAL SOCIAL WORKERS",
"identifier": "A4288",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACCBO CADC III",
"identifier": "17-01-0128",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.